COVID-19 Mitigation Behaviors by Age Group — United States, April–June 2020

CDC recommends a number of mitigation behaviors to prevent the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Those behaviors include 1) covering the nose and mouth with a mask to protect others from possible infection when in public settings and when around persons who live outside of one’s household or around ill household members; 2) maintaining at least 6 feet (2 meters) of distance from persons who live outside one’s household, and keeping oneself distant from persons who are ill; and 3) washing hands often with soap and water for at least 20 seconds, or, if soap and water are not available, using hand sanitizer containing at least 60% alcohol (1). Age has been positively associated with mask use (2), although less is known about other recommended mitigation behaviors. Monitoring mitigation behaviors over the course of the pandemic can inform targeted communication and behavior modification strategies to slow the spread of COVID-19. The Data Foundation COVID Impact Survey collected nationally representative data on reported mitigation behaviors during April–June 2020 among adults in the United States aged ≥18 years (3). Reported use of face masks increased from 78% in April, to 83% in May, and reached 89% in June; however, other reported mitigation behaviors (e.g., hand washing, social distancing, and avoiding public or crowded places) declined marginally or remained unchanged. At each time point, the prevalence of reported mitigation behaviors was lowest among younger adults (aged 18–29 years) and highest among older adults (aged ≥60 years). Lower engagement in mitigation behaviors among younger adults might be one reason for the increased incidence of confirmed COVID-19 cases in this group, which have been shown to precede increases among those >60 years (4). These findings underscore the need to prioritize clear, targeted messaging and behavior modification interventions, especially for young adults, to encourage uptake and support maintenance of recommended mitigation behaviors to prevent the spread of COVID-19.

The COVID Impact Survey collected data to provide national estimates of health, economic, and social well-being of U.S. adults, using a national probability sample covering approximately 97% of the U.S. population of non-institutionalized adults with a home address (3). Surveys were conducted in three waves (April 20–26, May 4–10, and May 30–June 8), without significant resampling of persons across waves. Analyses included a total of 6,475 online or telephone surveys of adults aged ≥18 years.* The response rate among those invited to participate ranged from 19.7% to 26.1% across the three survey waves. Following data collection, an iterative raking process was used to adjust for nonresponse, noncoverage, and under- and oversampling (5). Demographic weighting variables provided in the dataset were obtained from the 2020 Current Population Survey; estimates reflect the U.S. household population of adults aged ≥18 years.^† No personally identifying information was provided in the data file accessed by CDC.^§

Respondents were asked, “Which of the following measures, if any, are you taking in response to the coronavirus?” Of the 19 response options, three mitigation behaviors aligning with CDC recommendations were assessed: 1) “wore a face mask,” 2) “washed or sanitized hands,” and 3) “kept six feet distance from those outside my household.”^¶ Three social mitigation behaviors aligning with CDC considerations and White House guidelines from March and April 2020 also were selected for analysis: 1) “avoided public or crowded places,” 2) “cancelled or postponed social or recreational activities,” and 3) “avoided some or all restaurants.”**^,††,§§ Pearson’s Chi-squared test was used to assess differences in reported behaviors (individual and cumulative) by age, within each survey wave and stratified by face mask use, based on a significance level of α = 0.05. Logistic regression models were used to test statistical significance of time trends by assigning calendar week of data collection for each survey wave as a single linear predictor for individual and cumulative behavioral outcomes. All analyses were conducted in Stata ES (version 16.1, StataCorp.) with survey weights applied during analyses for nationally representative estimates.

Across survey waves, the majority of the weighted sample (range = 62%–65%) identified as Non-Hispanic or Latino White, and 50% identified as female; 14%–15% of respondents were aged 18–29 years. In April, 78% of adults aged ≥18 years reported wearing a mask; this increased to 83% in May and 89% in June (Table 1) (p<0.001). All other reported mitigation behaviors decreased from April 20–26 to early June (p<0.05), except avoiding some or all restaurants, which did not change significantly (Table 1) (Supplementary Figure 1: https://stacks.cdc.gov/view/cdc/95944). At each time point, >40% of all adults aged ≥18 years reported all six assessed mitigation behaviors (Table 2). Across all survey waves, reported prevalences of mitigation behaviors were highest among adults aged ≥60 years and lowest among those aged 18–29 years (Table 1) (Supplementary Figure 1: https://stacks.cdc.gov/view/cdc/95944). Age was also significantly associated with the cumulative number of reported mitigation behaviors across all survey waves, with young adults reporting engaging in fewer mitigation behaviors compared with older adults overall and at all time points (Table 2) (Figure).

Among adults who reported face mask use at each time point, a significantly higher percentage reported other mitigation behaviors compared with those who did not report mask use (Supplementary Figure 2: https://stacks.cdc.gov/view/cdc/95945). Among adults who did not report mask use, all other reported mitigation behaviors declined significantly from the April 20–26 wave to early June. Other mitigation behaviors also decreased over time among those who reported mask use, but to a much lesser extent, and only significantly for washing hands, maintaining a 6-foot distance, and cancelling or postponing social events. A higher percentage of adults who reported mask use also reported a higher cumulative number of other mitigation behaviors during the same period, compared with adults who did not report mask use (Figure). By early June, >45% of adults who did not report mask use reported one or fewer other mitigation behaviors (Figure). Overall, a significant positive association between age and the cumulative number of reported mitigation behaviors persisted over time among those who did and those who did not report mask use (Figure).

Acknowledgment

Danielle Barradas, CDC.

Corresponding author: Helena Hutchins, [email protected].

¹CDC COVID-19 Response Team; ²Data Foundation, Washington, DC; ³Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC.

References

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Abbreviations: CI = confidence interval; COVID-19 = coronavirus disease 2019.
* Wore a face mask, washed or sanitized hands, kept 6 feet of distance, avoided public or crowded places, canceled or postponed pleasure, social, or recreational activities and avoided some or all restaurants.
^† Chi-square p-value <0.05 for differences across age groups, by survey wave.
^§ Test for trend for overall change over time: p-value <0.001.
^¶ Test for trend for overall change over time for “avoided public or crowded places”: p-value = 0.002.

Abbreviations: CI = confidence interval; COVID-19 = coronavirus disease 2019.
* Wore a face mask, washed or sanitized hands, kept 6 feet of distance, avoided public or crowded places, canceled or postponed pleasure, social, or recreational activities and avoided some or all restaurants.
^† Test for trend for overall change in behavior over time p-value <0.001.
^§ Chi-square p-value <0.01 for differences across age groups, by survey wave.
^¶ Chi-squared p–value <0.05 for differences across age groups, by survey wave.

FIGURE. Percentage distribution of cumulative number of reported mitigation behaviors,* by age group and reported face mask use — COVID Impact Survey, United States, April–June 2020^{†,§,¶,**,††,§§}

Abbreviation: COVID-19 = coronavirus disease 2019.

* Wore a face mask; washed or sanitized hands; kept 6 feet of distance; avoided public or crowded places; canceled or postponed pleasure, social, or recreational activities; and avoided some or all restaurants.

^† Weighted to be representative of noninstitutionalized U.S. adults; values <5% not shown.

^§ Trend for overall change in behavior over time, p-value <0.001.

^¶ Chi-squared p-value <0.001 for differences in cumulative number of mitigation behaviors reported across age groups, within all survey waves.

** Chi-squared p-value <0.05 for differences in cumulative number of mitigation behaviors reported across age groups, within April and June waves only.

^†† Not inclusive of the survey item “wore a face mask.”

^§§ Trend for overall change in behavior over time p-value <0.05 (among those who reported wearing a mask: p-value = 0.003).